integumentary

Integumentary System Overview

  • Functions of the Skin:
    • Protection of internal organs
    • Thermoregulation via blood vessel dilation/constriction
    • Vitamin D synthesis through UV exposure

Skin Structure

  • Layers:
    • Epidermis: Outer layer, contains melanocytes.
    • Dermis: Inner layer, contains blood vessels, receptors for touch, pressure, and pain.
    • Subcutaneous Layer: Insulates body from temperature extremes.

Skin Glands

  • Eccrine Glands: Sweat for cooling.
  • Apocrine Glands: Thicker secretion, located in specific areas.
  • Sebaceous Glands: Produce oil for skin and hair lubrication.

General Skin Assessment

  • Health History: Assess for allergies and related conditions.
  • Inspection: Compare skin temperature bilaterally; consider skin tone variations.
  • Palpation: Light then deeper pressure to assess skin condition.

Skin Lesion Assessment

  • PQRST Framework:
    • P: Provocative/Palliative factors.
    • Q: Quality and Quantity of lesions.
    • R: Region of the body.
    • S: Severity of symptoms.
    • T: Time since onset.

Pressure Ulcer Stages

  1. Stage 1: Non-blanchable erythema, intact skin but red/discolored.
  2. Stage 2: Partial thickness loss of skin, may have blisters.
  3. Stage 3: Full thickness loss, may involve subcutaneous tissue without reaching muscle/bone.
  4. Stage 4: Full thickness loss with exposed bone, muscle, or tendon.
  5. Unstageable: Full thickness loss covered by slough or eschar.

Disorders of the Skin

Viral Disorders:

  • Herpes Simplex: Cold sores and genital sores.
  • Herpes Zoster (Shingles): Reactivation of varicella virus causing painful rash.

Bacterial Disorders:

  • Cellulitis: Deep skin infection.
  • Impetigo: Contagious with honey-colored crusts.

Fungal Disorders:

  • Tinea Infections: Ringworm affecting different body areas.

Inflammatory Disorders:

  • Contact Dermatitis: Inflammation due to irritants/allergens.
  • Eczema: Chronic inflammation, itchy red patches.

Tumors:

  • Keloids: Overgrowths of scar tissue.
  • Basal and Squamous Cell Carcinoma: Common skin cancers.
  • Malignant Melanoma: Characterized by the ABCDE rule.

Burns Classification

  • Degrees of Burns:
    • 1st Degree: Epidermis only, heals in 3-6 days.
    • 2nd Degree: Epidermis and part of dermis, healing in 10-21 days.
    • 3rd Degree: Full thickness, requires surgery.

Burn Care Phases

  • Emergent Phase: First 24-48 hours, prioritize airway and circulation.
  • Acute Phase: Wound care and infection prevention.
  • Rehabilitation Phase: Focus on restoring function and psychological support.

Nursing Process for Integumentary Disorders

  • Assessment: Identify anxiety, pain, knowledge deficits, risk for infection.
  • Interventions: Education on care, skin protection, prevention strategies.